News: Study finds EMR can improve care

Despite all the negative news surrounding EMR implementation, a new study aimed at reducing risk of central line-associated bloodstream infections (CLABSI) seems to show that creative inclusion of best practice checklists can actually help improve patient care.

Researchers at the Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford (LPCH) in California integrated enhanced patient checklists and implemented a unit-wide dashboard for patients with a central venous catheter at LPCH's 24-bed PICU. The EMR checklist monitored best practice bundles using documentation in the record. Color-coded indicators helped providers determine compliance with the standards listed on the checklist.

For example, the indicator would be red if a patient’s dressing needed changing. Red indicators caused the EMR to display a window explaining the reason for the indicator, the required action, and educational information related to the action. All this linked to a dashboard at the nurses' station that displayed patient information and to the electronic medical record.

After implementing the checklist and dashboard, CLABSI rates in the PICU at LPCH decreased from 2.6 per 1,000 line days to 0.7 per 1,000 line days. Daily documentation of line necessity increased from 20% to 73%. The checklist was used on 84% of rounds in the PICU and added an average of 37 seconds to the rounds time. This resulted in a change in the plan of care for approximately 39% of the rounds.

"There's tons of data in the EMR but it's overwhelming and almost useless to the provider if it can't be brought to them at the right point in their workflow in a meaningful way," says Natalie Pageler, MD, MEd, medical director of clinical informatics and a pediatric intensivist at Stanford Children's Health. "What we were really trying to do is take all of that data that's been dumped in there now and pull it out at the right places in their workflow to support the decision-making."

 Editor’s Note: Portions of this article were originally included in Medical Records Briefing.